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7 December 2007

A new survey suggests nearly half of all doctors don't report observed incompetence in their colleagues.

Researchers mailed a survey and a $20 incentive check to more than 3,000 doctors. More than 90 percent of the roughly 1,500 who answered said that physicians should always report an impaired or incompetent colleague to the proper authorities. But 45 percent also reported that they hadn't always done so.

A third of surveyed doctors also said they would order an unnecessary MRI scan just to get rid of a complaining patient, and eleven percent reported breaching patient confidentiality.

A new survey suggests nearly half of all doctors don't report observed incompetence in their colleagues.

Researchers mailed a survey and a $20 incentive check to more than 3,000 doctors. More than 90 percent of the roughly 1,500 who answered said that physicians should always report an impaired or incompetent colleague to the proper authorities. But 45 percent also reported that they hadn't always done so.

A third of surveyed doctors also said they would order an unnecessary MRI scan just to get rid of a complaining patient, and eleven percent reported breaching patient confidentiality.

The FDA has claimed that a new report prepared by the Eastern Research Group (ERG) showed it is difficult to create advisory committees free from conflicts of interest, because industry advisers have greater expertise. However, an independent analysis of the data shows just the opposite.

It would have taken a single FDA official just one week to replace all the advisers who had conflicts of interest on the four advisory committees analyzed in the study. Furthermore, the FDA would have been able to choose from nearly two potential unconflicted experts for every open slot.

Analysis also showed that these easily identifiable unconflicted experts would actually have been more qualified than the ones eventually chosen.

The Center for Science in the Public Interest (CSPI), along with other prominent science and consumer groups, has urged the FDA to adopt conflict-of-interest guidelines, which would ban anyone with greater than $50,000 a year in financial ties to industry from advisory committees, and deny a vote to anyone with lesser conflicts.

More than 17 girls a week have had adverse reactions, including seizures and numbness, to the HPV vaccine Gardasil since it started being widely used.

There have been reports of young girls fainting, experiencing seizures, dizzy spells and paralysis, and at least seven deaths have been linked to the vaccine.In the U.S., as many as 1700 women have suffered adverse reactions, as have hundreds more in other countries. The manufacturer has dismissed any association with the seven deaths, claiming the women died of unrelated thrombosis or heart attack.

4 December 2007

For years, when Minnesota physician Dr. Chris Balgobin saw patients with diabetes and high blood pressure, he found it difficult to counsel them about losing weight and exercise.Before slimming down, Dr. Balgobin found it difficult to talk to patients about weight loss.

That’s because Dr. Balgobin was overweight himself — at his heaviest, he carried 304 pounds on his 5-foot-6-inch frame.

“It was hard for me to tell them about losing weight and exercise because I’ve been big all of my life,'’ said Dr. Balgobin. “I would say, ‘Yes, it’s a struggle.’ But then I would say ‘they’ say to reduce calories and exercise. I could never put it on me as the authority figure.”

But in January, Dr. Balgobin, a family practice doctor for Fairview Health Services in Apple Valley, Minn., says he was inspired by one of his own patients who had lost 60 pounds through diet and exercise. He talked to his wife and together they decided to change their eating habits, exercise more and try to lose weight together.Since losing 120 pounds, Dr. Balgobin’s relationship with patients has markedly changed.

Dr. Balgobin said he used tools on DiscoveryHealth.com to calculate his metabolic rate and calorie needs. He cut out fast food and began counting calories, and he and his wife began working out at a health club together. He also began eating breakfast regularly.

Dr. Balgobin has since lost 120 pounds. He says weight loss has not only changed his life, but it has changed his relationship with his patients. A bulletin board filled with pictures of him with babies and patients allows patients to see “all the different sizes of me,’’ he said. “Now I can say, ‘This is what I’ve done.’ ”

Studies show that the health of your doctor does matter. Doctors who eat well and exercise regularly are more likely to counsel their patients to do the same thing, and patients are more likely to listen, research shows. Earlier this year, the medical journal Preventive Medicine published a survey of more than 2,300 graduating medical school students that showed student-doctors with healthy habits were more likely to talk to their patients about prevention strategies like diet and exercise. Another report, called the Women’s Physician Health Study, also found that doctors tend to advise patients about health issues that they themselves practice — like eating a low-fat diet or using sunscreen.

It may seem obvious, but lots of doctors don’t practice what they are supposed to be preaching. A 2004 study of 85,000 male physicians found that 44 percent were overweight and 6 percent were obese. Harvard physician Dr. JoAnn Manson, a co-author of that study, told Stanford Medicine magazine that physicians need to be role models. “We will have much more credibility promoting lifestyle modifications to our patients if we also ‘walk the walk,’” Dr. Manson told the magazine, which recently wrote about the link between doctor and patient health.

Dr. Balgobin said that since losing weight, he talks more to patients about healthful living and how it has not only improved his life, but improved his marriage. Some of his patients have even joined his health club, he said.

“Being a physician, people see you every day,’’ said Dr. Balgobin. “Everything is how you present yourself. I want to be an inspiration to them.’’

At breakfast recently a friend of mine passed on the scrambled eggs. “I’m watching my cholesterol,'’ he said. Another woman I know only orders Egg Beaters, which are essentially cholesterol-free orange-colored egg whites.

Of all the commonly consumed foods, eggs contain the highest amounts of cholesterol, and that’s why many people shun them. Now, the American Egg Board is bringing back its “Incredible Edible Egg” campaign to reiterate the health benefits.

So are eggs good for you or bad for you? I asked Dr. Walter Willett, Harvard University’s famed nutritionist, for his take.

“Dietary cholesterol has been greatly oversold as a health concern, in part because it has a small effect on blood cholesterol levels,'’ said Dr. Willett, who has never received funding from the egg industry. Eggs, in particular, have gotten a bad rap. “Some of the foods that contain high cholesterol, such as eggs, have many other healthy components,'’ he said.

Egg yolks, organ meat, shellfish, whole-fat dairy products and red meat are rich sources of dietary cholesterol. But the biggest influence on blood cholesterol level is the mix of fats in the diet, not how much cholesterol you eat in food.

The average person makes about 75 percent of blood cholesterol in his or her liver, while the rest is absorbed from food. One of the biggest problems with giving up eggs is that people turn to other breakfast foods like bagels with cream cheese, pastries and muffins. These are loaded with unhealthy saturated fat, which increases blood cholesterol levels far more than the dietary cholesterol found in eggs. The downside of eggs is that many people only eat them cooked in butter or oil, or with sausage, also loaded with saturated fat.

There are a few caveats. Egg consumption has been linked to a higher risk of heart trouble in people with diabetes. And a small number of people are unusually sensitive to dietary cholesterol — in them, foods like eggs can disproportionately increase blood cholesterol.

Still, said Dr. Willett, “the large majority can consume eggs in reasonable amounts.” For a more lengthy explanation of the impact of dietary cholesterol and fats on your health, check out The Nutrition Source from the Harvard School of Public Health. And Northwestern University has a useful fact sheet comparing dietary cholesterol and saturated fat in various foods.

Is there more to a carrot than beta carotene? Is lycopene the best we get from tomatoes? And when we heap our plates with salmon, are we serving up something other than omega-3s?

For years the scientific community has viewed individual vitamins and nutrients as the best that food has to offer. Nutrition studies have isolated beta carotene, calcium, vitamin E and lycopene, among other nutrients, in order to study their health benefits in the body.

But now, after several vitamin studies have produced disappointing results, there’s a growing belief that food is more than just a sum of its nutrient parts. In a recent commentary for the journal Nutrition Reviews, University of Minnesota professor of epidemiology David R. Jacobs argues that nutrition researchers should focus on whole foods rather than only on single nutrients. “We argue for a need to return to food as the source of nutrition knowledge,'’ writes Dr. Jacobs with co-author Linda C. Tapsell, a nutrition researcher at the University of Wollongong in Australia.

Dr. Jacobs believes that nutrition science needs to consider the effects of “food synergy,'’ the notion that the health benefits of certain foods aren’t likely to come from a single nutrient but rather combinations of compounds that work better together than apart. “Every food is much more complicated than any drug,’’ said Dr. Jacobs. “It makes sense to want to break it down. But you get a lot of people talking in the popular press about carbohydrates and fats in particular as if they were unified entities. They’re not. They’re extremely complicated.’’

The narrow focus on the health effects of single nutrients stems from the earliest days of nutrition research. In 1937, two scientists won a Nobel Prize for identifying vitamin C as the essential component in citrus fruit that prevents scurvy. The finding spurred interest by the scientific community to study other biologically active nutrients in foods.

For as long as observational studies have shown that diets rich in fruits and vegetables, unsaturated fat and fish, among other things, are associated with better health, nutrition researchers have been busily deconstructing these foods to identify the most potent nutrients. For example, vitamin E has been widely studied as a heart protector.

But attributing the broad health benefits of a diet to a single compound has proven to be misguided. Several studies have suggested an association between diets rich in beta carotene and vitamin A, for instance, and lower risk for many types of cancer. But in a well-known 1994 Finnish study, smokers who took beta carotene were found to have an 18 percent higher incidence of lung cancer. In 1996, researchers gave beta carotene and vitamin A to smokers and workers exposed to asbestos. But the trial had to be stopped because the people taking the combined therapy showed markedly higher risks for lung cancer and heart attacks.

Since then, studies of other vitamins, notably vitamins E and B, have also failed to show a benefit. Manufacturers say the problem is that vitamins are too often examined in sick people while the real benefit may be in preventing disease. But Dr. Jacobs notes that the better explanation may simply be that food synergy, rather than the biological activity of a few key nutrients, is the real reason that certain diets, like those consumed in the parts of the Mediterranean and Japan, appear to lower the risks of heart disease and other health problems.

“People ask me what vitamins they should take,’’ said Dr. Jacobs. “I say ‘Don’t take any. Just make sure you have a nutrient-rich diet.’ ’’

3 December 2007

A decade after the U.S. government began trying to ensure that prescription drugs used to treat children are safe, doctors still have very little information to guide them.

For many years, the testing of drugs on children was regarded as unnecessary and unethical, but this resulted in medications being given to children with no testing at all. In 1997, the FDA Modernization Act gave companies six extra months to sell a drug without competition if they studied it in children, and the 2003 Pediatric Research Equity Act authorized the FDA to require companies to test new drugs on children before they are approved for sale.

But even today, about two-thirds of the thousands of medications given to children remain untested on them.

What little has been discovered thus far has been troubling. A highly effective adult migraine drug turned out to be worthless in children, and sometimes caused serious side effects such as strokes. An asthma inhaler could stunt children's growth, and a narcotic patch routinely used to relieve pain could cause fatal overdoses.